Pity the poor software vendors

Yes, we know that no one has ever said that and really meant it, but this week has been a tough one to be a clinical software vendor, what with being unfairly maligned by a high-profile medical college, caught up in a state election campaign and otherwise taking the blame for all manner of ills.

Poor old EPAS in Adelaide came in for yet another beating from local rag the Advertiser last week, which reported that 25,000 outpatients were missing an urgency rating following a transfer from the old booking system to EPAS, which clinicians will now have to fix up and are rightly grumbling about.

While this problem was caused by the previous system and not the new one, you’d be forgiven for thinking it was all the fault of EPAS and yet another stumble in its storied journey. On Friday, former senator Nick Xenophon released his health policy, which simply copies the Liberal Party's stated policy from last year – what a surprise – to pause the roll out of EPAS while its worth is re-evaluated.

Not even the AMA is calling for that as they just want the problems to be fixed and to get on with it, but everyone loves to hate on EPAS, it seems. The real surprise is that it wasn’t blamed for Royal Adelaide’s potentially catastrophic power failure this week, when the lights went out while people were in surgery. In a moment of light relief, so to speak, the ABC reported that some patients had already been “anaesthetised and incubated”, leading us to wonder whether they were being operated on or something was about to hatch.

Something that was truly catastrophic was the avoidable death of a 54-year-old man at Macquarie University Hospital in 2015, which was in the news this week due to an inquest into the matter. We won't harp on this as it's an absolute tragedy all around, but while some fingers were pointed at the TrakCare clinical information system, which had just been rolled out at the hospital and which the doctor in question had little training in, it is clear from this report that the inbuilt warning messages about opioid prescribing in Trak were overlooked and the disaster was a case of multiple examples of human error. Alarms and alerts about potential medication interactions are often cited as an annoyance to doctors, but clearly they have their value.

Our biggest story this week concerned the release of a joint statement from the RACGP and ADHA about a project we first reported on back in December, which put forward the idea of developing a minimum set of requirements for general practice software. The main thrust of the statement was that the college and ADHA were intent on ensuring that such software was “usable, secure, interoperable and fit for purpose”. But as the medical software vendor association argues, who's saying it isn't?

The phrase “usable, secure, interoperable and fit for purpose” and variations of such date back quite a few years but they don't concern GP software. It's actually a demand that has been repeated regularly by doctors' groups about the essential requirements, still sorely lacking, of the PCEHR/MyHR. The argument goes that while interoperability still needs some work for GP software, if it wasn't usable, safe and fit for purpose, no one would be buying it.

We had a quick chat to the RACGP's eHealth committee chairman Nathan Pinskier on Thursday about the hoo-ha and he assures us that the plan is still as it was when the parties all last met, that there is still a free-ranging discussion to be had about whether it was even desirable for a minimum set of standards to be devised, and if so, what it would look like. We get the feeling that Monday's statement was a mistake but that it would soon be rectified by the parties getting together again over a nice cup of tea and a biscuit.

We'll leave our thoughts at that but we'd like to know yours. This week's poll question is: do you think clinical software vendors come in for unfair criticism?

To vote in our weekly polls, sign up for our weekend edition or leave your comments below.

In last week's poll we asked: Do you think new technologies really can reduce the cost of healthcare? 75 per cent said yes, 25 per cent said no.


0 # Mark Santamaria 2018-02-10 11:30
The poll question this week is too black and white and this issue requires scales of grey. Any company should be criticised when their product does not perform as intended, including software vendors. The deeper issue here is the satisfaction of the users which is usually not taken into account, but disgruntled users will be quick to point the finger when anything adverse (even if the product was not at fault) occurs. My impression is that the SA system is not winning the hearts and minds of the users (clinicians). This is what all software vendors should be focusing on - the user experience, which means that users can perform their tasks simply and efficiently and the information they need is presented appropriately without wasting time. If we are talking about the user experience in current hospital based clinical information systems then the data from around the world suggests software vendors need to improve greatly and are deserving of criticism.
0 # Glenn Rosendahl 2018-02-11 14:10
I think back to the time - two decades ago - when about 10 GP clinical management programs first appeared. Initially I was only interested in prescription printing, and I realised that the arrival of this software would make solo practice impossible. One would need two linked computers - that was a network. Expensive to buy, full of 'bugs', one would spend half one's time managing IT rather than seeing patients - and one would need to become and IP expert. To employ a cost-effective IT expert would require at least 3 doctors in a group. Probably more. I was not going to find that opportunity in the ACT, so I moved to the Gold Coast. At my first clinic I found that each screen change was taking up to 30 seconds. The network was underpowered, and my terminal, being the most recent in the system, was starved of resources. So I looked elsewhere. One clinic was operating a dual system - computer network AND paper. I knew this would be onerous. At another clinic, I was told that they waited at least 3 months before installing a new upgrade. All the programs were 'buggy', and they were all bringing out frequent upgrades, to stay ahead of the competition. I think it took 5 years for things to settle down, and MD and BP finally rose to the top. It was also obvious to me that most of my compatriots could not touch type, and the computer medical record was informed by the prescription, imaging and pathology orders - and very little else. And these were programs, and are programs, only for GPs, practice nurses and front office staff to write to. And - by and large - they are bereft of the algorithmic questionnaires that bedevil their North American counterparts. (This will change when we are confronted with the new medical records set up for the 'My Health Homes'.)
My point is that it takes time to bed down an new program like EPAS. Years, not months. And it takes an equivalent time for the people who will be expected to use it, to become comfortable with it.
Which is why the two Ramsay Hospitals on the Gold Coast still have voluminous paper records. And many specialist offices still apparently run on paper. (My suspicion is that there is now a word processor in the picture, with template paragraphs, which would mean much less time spent in actual dictating and in secretarial typing. But the appropriate statements are altered, and numbers inserted - and this is certainly not a criticism of that.
In my first year of high school I studied Latin. And the first aphorism I was taught was 'festina lente'. 'Hasten slowly'.
+1 # Ian Colclough 2018-02-11 19:47
First and foremost the RACGP's eHealth committee chairman Nathan Pinskier should should be focusing on the highest priority for "the college and ADHA" (which, if we are to believe what the ADHA and RACGP keep telling us about the enormous benefits of the My Health Record to doctors and their patients) should be on ensuring that My Health Record software is “usable, secure, interoperable and fit for purpose". Until they can convincingly demonstrate to doctors and vendors,they have got that 'right' they should desist from being so presumptive as to telling vendors what they need to do to improve their software functionality.

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